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Thursday, 24 May 2012
Page: 5523


Mr LAMING (Bowman) (13:25): This is an important debate about the healthcare of this country. This is an important debate about whether you invest $692 million in non-service-providing bureaucracy. This is a debate about whether, having set up 10 authorities in health, you set up an 11th. This is a debate about just how much focus you can place on the back-end, fiddling with the structure of our health system, without putting any skin in the game at the front. This is fundamentally about how much money is ripped out of service provision in order to fund this government's preoccupation with setting up more authorities and spending more money on layers of bureaucracy that once was done by something called the Department of Health.

I can understand that the more consultants one employs, the more you need a panel to monitor them; and that in turn is watched by committees; and that in turn is guided by councils and is ultimately answerable to authorities one after the other. I can also see good reason, from the Left side of politics, to simply generate more and more of these layers and call it transparency. I can understand why ultimately, when you are trying to guarantee more outcomes, and a floor in outcomes, in the end you simply need more people watching the system to achieve that. I can also see, from where those people come from, why that is so important to them.

But this debate is also about whether we are prepared to turn our health system around and put the patient at the centre of that experience, whether we are going to unlock resources and make them available to the clinicians on the frontline that know how to make the system work better but are currently disempowered to do so. Today's debate is quite simply about how far we are prepared to go before we have a system that is completely out of balance, with a focus on bureaucracy and not enough on the patient.

There are actually truly important things to be focused on in health policy, but this is by an administration that spent not $1 and not one cent of the stimulus package on health. If healthcare were something truly important, Minister Plibersek, tell me exactly what in the stimulus package was spent on healthcare and what proportion of it was spent on health. You will always have a procession of government MPs from both sides, when they are incumbent in government, saying they are spending more than their predecessors, but that is not the debate. Healthcare is growing and Australia's expenditure on health is approaching 10 per cent of GDP. Every administration will claim they spend more than their predecessor. No, this is the debate about just how many layers of bureaucracy are needed for a system to work. At some point we have to say that is enough.

I can understand wishing to continue the important roles of many of these commissions and councils. But we also need to ask ourselves how big they have to be. This is not a debate about the ends, it is a debate about the means by which we get there. If I go through the $118 million over four years on the National Health Performance Authority and the other nine authorities that have been established—not even including those that already existed and are being continued—at some point we have to say, is this the best way to spend the money? You only have to look at the budget—the cold, hard reality of every budget—to see the context in which these authorities are being set up. It is simply by ripping money off service providers and simply by building less Indigenous health infrastructure. It is about removing money from important things like delivering public and preventative healthcare. Let's go through it: I am not giving you this data, I am reading it from the budget papers—$3.3 million cut from substance misuse programs, particularly in Indigenous Australia. If there is one thing you ask people in Central Australia most it is, 'Where are the support services for those who need them most?' There was $68 million cut from the health workforce programs and $75 million cut from Indigenous health infrastructure. This is the currency that builds these new authorities.

I am not for a moment going to say that we do not need a system to get the Commonwealth and states working together, but I am criticising the size, the mechanism and the delays in how it is being done. I am criticising the fact that there has been a complete focus on the back end of the health system by an administration that has lost sight of the front end. There is effectively no communication with rural doctors about ways to retain them in practice or about the reforms around geographical classification systems. This is a government in denial. I say, simply, that what we need to be doing in Australia is pick up what is truly at the forefront to give us a cutting-edge health system. We have seen this in other nations around the world who have freed themselves from the almost puerile debate about the fact that there is no role for private health in medicine. Parts of Europe have effectively moved on from that debate.

We have no movement whatsoever on workforce productivity and no action around the Productivity Commission reports. The reality is that in public radiotherapy in this country you will wait 10 weeks on average for treatment if you do not have private health insurance, but there is no movement from the other side to fix that problem. There is no movement from the Commonwealth. There is no movement from the fact that they have 21 public health staff per linear accelerator in the public system and about 11 to 12 in the private system. There is no answer to that.

In relation to mental health they have been dragged kicking and screaming to a solution after leaders from mental health forums had to resign their positions to get some action from this government. In the big area of time to commercialisation, pharmacogenomics, which is the need to have companion diagnostics for more efficient prescribing, none of that is being addressed, where massive savings exist. Of course, in this proposition we simply have Health Workforce Australia, with a considerable amount of money, working slowly through the modelling process to fund solutions particularly for regional and remote Australia, for providers practising at top of licence and in making sure we are providing the workforce that we will need in decades to come.

At the moment we have deficits with doctor numbers, deficits with nursing numbers and no other answer from this government except, 'We'll train more.' That is right—they will simply turn the taps on and hope they end up in the right location. This is the product of focusing on the back end where you take everyone's job, make them insecure, cancel the divisions of general practice and throw it all up in the air. What do you think stakeholders do? They are completely panicked about where they will be next. They have no idea whether they will get a share of the Medicare local pie. Do you know what they do for two or three years? They stop criticising the government, they grab one-page press releases and say, 'What are we going to do? How does my job survive? How can I make this system work that has been imposed on me?' That is understandable. I have always said that, as health is probably the most complex system run by a government, reform of it is a privilege that is earned; it is not an automatic right of incumbency.

This is a government that did nothing except talk about a takeover and then not do it and then come up with a plan that states rejected. Then, in this period of absolutely desolate despondency in a government that is completely and utterly distracted from the main game, we have these flirtations with truthfulness. The former health minister said:

… we don’t want to increase the size of the bureaucracy—it’s not appropriate for us to establish an authority where there is not a need to do so. There will need to be people who can process essentially the cheques that need to be paid through to local hospital networks, but it doesn’t require an authority.

I rest my case. The former health minister said that and yet here we are today consuming valuable time that could be spent finding solutions for remote and Indigenous Australian health delivery—but we are not. Why not? Because the price of setting up these administrations is removing money from the Cape York welfare reforms. That is right, with new ways of looking after children, identifying those most at risk, the direct instruction model of education to keep kids at school, not just once in the morning but all day, enjoying school, staying at school and graduating school. That money gets ripped to do what we are debating today—the 11th authority. It is like you get one extra authority thrown in when you establish your first 10.

We are quite happy to talk about the importance of these reforms and of jurisdictions working together, but you read a set of budget papers and there are 38 employees in rural health services, then you read the next set of budget papers and there are 98 employees. I do not want this to be a flippant comment, but once there was a department of health to do these things. I do not mind us finding smarter ways to do things but what we are doing here is the lazy approach. It is more layers, more levels and no necessary agreement from our state colleagues on the way this is being done.

When the political obituary is written of this government they in health will say that they fiddled with the back end but never took the hard yards at the front. It is a government quite happy to fiddle with financing, as they do around school reforms, but they are not looking at quality. The one thing that a government can do is focus on quality of care. Have there been any reforms around practice incentives? No—just move the bar higher to save a few quid. Have there been any reforms around chronic disease management so that we get guaranteed outcomes when a patient comes to a GP? No—just keep paying the money out without any guarantee of quality outcomes.

The government has been incumbent now for four years. It is time now to take some responsibility for the outcomes of the health system and to stop fiddling with the back end. Get your head out from around the back and come and live with a local remote nurse for a week and come and see chronic renal services being delivered in Central Australia in the Western Desert. Get out of Canberra, get out of the beltway and start looking after local service providers. Free them up to unlock the potential of this great health system.